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Huysseune A, Witten PE. Continuous tooth replacement: what can teleost fish teach us? Biol Rev Camb Philos Soc 2024; 99:797-819. [PMID: 38151229 DOI: 10.1111/brv.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023]
Abstract
Most tooth-bearing non-mammalian vertebrates have the capacity to replace their teeth throughout life. This capacity was lost in mammals, which replace their teeth only once at most. Not surprisingly, continuous tooth replacement has attracted much attention. Classical morphological studies (e.g. to analyse patterns of replacement) are now being complemented by molecular studies that investigate the expression of genes involved in tooth formation. This review focuses on ray-finned fish (actinopterygians), which have teeth often distributed throughout the mouth and pharynx, and more specifically on teleost fish, the largest group of extant vertebrates. First we highlight the diversity in tooth distribution and in tooth replacement patterns. Replacement tooth formation can start from a distinct (usually discontinuous and transient) dental lamina, but also in the absence of a successional lamina, e.g. from the surface epithelium of the oropharynx or from the outer dental epithelium of a predecessor tooth. The relationship of a replacement tooth to its predecessor is closely related to whether replacement is the result of a prepattern or occurs on demand. As replacement teeth do not necessarily have the same molecular signature as first-generation teeth, the question of the actual trigger for tooth replacement is discussed. Much emphasis has been laid in the past on the potential role of epithelial stem cells in initiating tooth replacement. The outcome of such studies has been equivocal, possibly related to the taxa investigated, and the permanent or transient nature of the dental lamina. Alternatively, replacement may result from local proliferation of undifferentiated progenitors, stimulated by hitherto unknown, perhaps mesenchymal, factors. So far, the role of the neurovascular link in continuous tooth replacement has been poorly investigated, despite the presence of a rich vascularisation surrounding actinopterygian (as well as chondrichthyan) teeth and despite a complete arrest of tooth replacement after nerve resection. Lastly, tooth replacement is possibly co-opted as a process to expand the number of teeth in a dentition ontogenetically whilst conserving features of the primary dentition. That neither a dental lamina, nor stem cells appear to be required for tooth replacement places teleosts in an advantageous position as models for tooth regeneration in humans, where the dental lamina regresses and epithelial stem cells are considered lost.
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Affiliation(s)
- Ann Huysseune
- Research Group Evolutionary Developmental Biology, Biology Department, Ghent University, K.L. Ledeganckstraat 35, Ghent, B-9000, Belgium
- Department of Zoology, Faculty of Science, Charles University, Vinicna 7, Prague, 128 44, Czech Republic
| | - P Eckhard Witten
- Research Group Evolutionary Developmental Biology, Biology Department, Ghent University, K.L. Ledeganckstraat 35, Ghent, B-9000, Belgium
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Djusse ME, Gaspari V, Morselli S, Rapparini L, Foschi C, Ambretti S, Lazzarotto T, Piraccini BM, Marangoni A. Antimicrobial resistance determinants in the oropharyngeal microbiome of 'men having sex with men' attending an sexually transmitted infection clinic. Int J STD AIDS 2024:9564624241255163. [PMID: 38760931 DOI: 10.1177/09564624241255163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
BACKGROUND 'Men having sex with men' (MSM) represent a key population with a significant prevalence of pharyngeal Neisseria gonorrhoeae (NG) infections and a high rate of antimicrobial resistance genes in the pharyngeal microbiome. As NG can acquire antibiotic resistance genes from other commensal oropharyngeal bacteria, monitoring the prevalence of these resistance determinants is critical to curtail the spread of NG-resistant strains. PURPOSE AND RESEARCH DESIGN Here, we assessed the distribution of five resistance genes (pen (A), mtr (R), gyr (A), par (C), msr (D)) in the oropharynx of 164 MSM, attending an Outpatient clinic for STI screening. RESULTS The most frequently detected resistance gene was msr (D) (88.4%), followed by gyr (A) (67.1%). The distribution of resistance genes was not influenced by pharyngeal gonorrhea nor by the HIV status, whereas a younger age was associated with mtr (R) presence (p = .008). Subjects using mouthwash exhibited significantly lower levels of mtr (R) (p = .0005). Smoking habit was associated with a higher prevalence of par (C) (p = .02). A noteworthy association was observed between the presence of msr (D) gene and the use of antibiotics (p = .014). CONCLUSIONS Our findings reveal an enrichment of antimicrobial resistance genes in the oropharynx of MSM. These insights could aid in the development of screening programs and antimicrobial stewardship initiatives targeting populations at heightened risk of pharyngeal gonorrhea.
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Affiliation(s)
- Marielle Ezekielle Djusse
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Valeria Gaspari
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sara Morselli
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luca Rapparini
- Section of Dermatology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Claudio Foschi
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Ambretti
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Section of Dermatology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Antonella Marangoni
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Sarkar S, Seth C, Dutta M, Bandyopadhyay SN. Solitary Isolated Oropharyngeal Neurofibroma Presenting With Dysphagia in the Setting of Von Recklinghausen's Disease. Ear Nose Throat J 2024:1455613241249022. [PMID: 38634319 DOI: 10.1177/01455613241249022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
A 24-year-old man with von Recklinghausen's disease presented with complaints of difficulty in swallowing for 6 months and change of voice for 3 months. He also had recent-onset difficulty in breathing. Telelaryngoscopy and subsequent contrast-enhanced computed tomography scan revealed a well-defined, smooth submucosal mass in the oropharynx (attached to the posterior pharyngeal wall, superior to the level of left aryepiglottic fold), obscuring the ipsilateral pyriform fossa, and nearly blocking the pharyngeal lumen. The mass was removed with endoscopic coblation-assisted laryngeal surgery, and subsequent histopathology revealed it to be neurofibroma. Neurofibromas are rare neoplasms to be encountered in the oropharynx. However, in the setting of von Recklinghausen's disease (neurofibromatosis type 1), one or more well-demarcated, submucosal nodular lesions in the upper aerodigestive tract may be considered as neurofibromas, and workup and treatment should be directed accordingly based on this clinical presumption. Endoscopic coblation during laryngeal surgery can effectively be used as a surgical tool to excise such lesions. It provides a relatively bloodless field compared to the conventional cold steel excision, and reduces the risk of complications at surgery and during the follow-up period. This clinical record illustrates the presentation and management of a solitary, isolated oropharyngeal neurofibroma in a man suffering from von Recklinghausen's disease. It further emphasizes the role of endoscopic coblation-assisted laryngeal surgery in this setup, and the need to maintain a low threshold of suspicion in having a provisional clinical diagnosis of such lesions.
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Affiliation(s)
- Shrita Sarkar
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, West Bengal, India
| | - Chandan Seth
- Department of Otorhinolaryngology and Head-Neck Surgery, M R Bangur Super Speciality Hospital, Kolkata, West Bengal, India
| | - Mainak Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Saumendra Nath Bandyopadhyay
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, West Bengal, India
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Hamud A, Brodsky A, Khnifes R. A Diagnostic Challenge: Toxoplasmosis Masquerading as Tonsillar Neoplasm. Laryngoscope 2024; 134:1741-1743. [PMID: 37672665 DOI: 10.1002/lary.31036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
This case report elucidates an uncommon manifestation of toxoplasmosis characterized by an ulcerative oropharyngeal lesion and cervical lymphadenopathy, which intriguingly simulated a tonsillar neoplasm. The patient, a 28-year-old immunocompetent woman, reported symptoms such as a persistent sore throat, unilateral neck pain, and otalgia. Despite the initial clinical impressions, a diagnostic left subtotal tonsillectomy revealed no malignancy but marked acute and chronic inflammation. A comprehensive investigation subsequently indicated a recent primary infection with Toxoplasma gondii, as evidenced by the presence of high IgM antibodies and low IgG avidity. This unique case underlines the significance of incorporating toxoplasmosis into the differential diagnosis of oropharyngeal lesions, thereby necessitating a meticulous approach to laboratory testing. Laryngoscope, 134:1741-1743, 2024.
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Affiliation(s)
- Amir Hamud
- Department of Otolaryngology, Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel School of Technology, Haifa, Israel
| | - Alexander Brodsky
- Department of Otolaryngology, Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel School of Technology, Haifa, Israel
| | - Riad Khnifes
- Department of Otolaryngology, Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel School of Technology, Haifa, Israel
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Ferris RL, Mehanna H, Schoenfeld JD, Tahara M, Yom SS, Haddad R, König A, Witzler P, Bajars M, Tourneau CL. Xevinapant plus radiotherapy in resected, high-risk, cisplatin-ineligible LA SCCHN: the phase III XRay Vision study design. Future Oncol 2024; 20:739-748. [PMID: 38197296 DOI: 10.2217/fon-2023-0774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
There is a significant unmet need and lack of treatment options for patients with resected, high-risk, cisplatin-ineligible locally advanced squamous cell carcinoma of the head and neck (LA SCCHN). Xevinapant, a first-in-class, potent, oral, small-molecule IAP inhibitor, is thought to restore cancer cell sensitivity to chemotherapy and radiotherapy in clinical and preclinical studies. We describe the design of XRay Vision (NCT05386550), an international, randomized, double-blind, phase III study. Approximately 700 patients with resected, high-risk, cisplatin-ineligible LA SCCHN will be randomized 1:1 to receive 6 cycles of xevinapant or placebo, in combination with radiotherapy for the first 3 cycles. The primary end point is disease-free survival, and secondary end points include overall survival, health-related quality of life, and safety.
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Affiliation(s)
- Robert L Ferris
- University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA
| | | | | | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Sue S Yom
- University of California San Francisco, San Francisco, CA 94143, USA
| | | | | | | | | | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris-Saclay University, Paris, France
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Liu J, Zhang X, Zhao Q, Mu X, Yang C, Ning Y, Xiong X, Qin X, Chen L. Effects of oropharyngeal administration of own mother's milk on oral microbial colonization in very low birth weight infants fed by gastric tube: A randomized controlled trial. Immun Inflamm Dis 2024; 12:e1247. [PMID: 38629781 PMCID: PMC11022609 DOI: 10.1002/iid3.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/10/2024] [Accepted: 03/31/2024] [Indexed: 04/19/2024] Open
Abstract
AIMS The aim of the present study was to explore the effect of oropharyngeal mother's milk administration on oral microbial colonization in infants fed by gastric tube at different time points. METHODS Infants (n = 116) with birth weight <1500 g were randomly allocated into two groups which both received breast milk for enteral nutrition. The control group (n = 51) accepted oropharyngeal normal saline administration. The experimental group (n = 53) accepted oropharyngeal mother's milk administration before fed by gastric tube once every 3 h over 21 days after birth. We analyzed the oral microbiota at initiation and 7 and 14 and 21 days later using 16S DNA amplicon sequencing. RESULTS There were no difference in oral microbial diversity between the two groups at any time point, but diversity decreased significantly over time in both groups. On the first day of life, the oral microbiota of the infant in the experimental and control groups consisted mainly of Firmicutes (7.75%, 6.18%) and Proteobacteria (68.65%, 68.69%), respectively. As time increases to 21 days after birth, Firmicutes (77.67%, 77.66%) had replaced Proteobacteria (68.65%, 68.69%) as the predominant phylum. DISCUSSION From birth to 21 days after birth, oropharyngeal mother's milk administration did not change the diversity and structural composition of the oral microbiota. The oral microbial diversity of infants declined significantly over time. Firmicutes had replaced Proteobacteria as the predominant phylum.
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Affiliation(s)
- Jie Liu
- Department of Traditional Chinese Medicine Gynecology, Pediatric Neurorehabilitation Department, Department of NeonatologyShenzhen Maternity and Child Healthcare HospitalShenzhenChina
| | - Xiyang Zhang
- Department of Traditional Chinese Medicine Gynecology, Pediatric Neurorehabilitation Department, Department of NeonatologyShenzhen Maternity and Child Healthcare HospitalShenzhenChina
| | - Qian Zhao
- School of NursingShanxi University of Chinese MedicineTaiyuanShanxiChina
| | - Xiaohe Mu
- Department of Critical care medicineShaanxi Province Kangfu HospitalXi'anChina
| | - Chuanzhong Yang
- Department of Traditional Chinese Medicine Gynecology, Pediatric Neurorehabilitation Department, Department of NeonatologyShenzhen Maternity and Child Healthcare HospitalShenzhenChina
| | - Yan Ning
- Department of Traditional Chinese Medicine Gynecology, Pediatric Neurorehabilitation Department, Department of NeonatologyShenzhen Maternity and Child Healthcare HospitalShenzhenChina
| | - Xiaoyun Xiong
- Department of Traditional Chinese Medicine Gynecology, Pediatric Neurorehabilitation Department, Department of NeonatologyShenzhen Maternity and Child Healthcare HospitalShenzhenChina
| | - Xiaoling Qin
- Department of Traditional Chinese Medicine Gynecology, Pediatric Neurorehabilitation Department, Department of NeonatologyShenzhen Maternity and Child Healthcare HospitalShenzhenChina
| | - Lilian Chen
- Department of Traditional Chinese Medicine Gynecology, Pediatric Neurorehabilitation Department, Department of NeonatologyShenzhen Maternity and Child Healthcare HospitalShenzhenChina
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Liao JY, Huang CY, Liao WC, Kang BH, Chang KP. Application of 3D-Printed Model in the Cervical Spine Osteochondroma Surgery: A Case Report. Ear Nose Throat J 2024; 103:NP185-NP189. [PMID: 34628970 DOI: 10.1177/01455613211040577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 73-year-old woman having a throat lump sensation and dysphagia for the past several months presented at our otorhinolaryngology outpatient clinic. A physical examination disclosed a protruding subepithelial mass over the right tonsil fossa. The mass was not tender and had no mucosal lesions or signs of active infection. Therefore, we arranged face and neck computed tomography scans, which reported a solitary osseous lesion over the anterior-right aspect of the C1-2 joint. Considering the rarity and unfamiliar anatomy of this disease, we built a 3D-printed model to assist with the surgical rehearsal of the procedure as well as with a preoperation discussion with the patient and her family. We arranged a combined Otolaryngology-Neurosurgery department approach after discussion with the neurosurgeon and successfully removed the lesion without sacrificing the overlying longus capitis muscle. The pathology examination revealed no evidence of malignancy. The final diagnosis was cervical spine solitary osteochondroma. The patient had a complete recovery of both oral cavity and normal swallowing function. No tumor recurred during the 3-year follow-up. On the basis of this case, in-house 3D-printing technology can offer a rapid, reliable model for an interdisciplinary team to use to enhance personalized presurgical planning, thus providing better patient engagement during hospitalization.
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Affiliation(s)
- Jyun-Yi Liao
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Chien-Yu Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Wei-Chuan Liao
- Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Bor-Hwang Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Kuo-Ping Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
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Magliulo G, Iannella G, Casale M, Vicini C, Pace A. Barbed Stayed Bridge Pharyngoplasty (BSBP). Laryngoscope 2024. [PMID: 38554034 DOI: 10.1002/lary.31425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024]
Affiliation(s)
| | | | - Manuele Casale
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Annalisa Pace
- Department of 'Organi di Senso', University "Sapienza", Rome, Italy
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Abdul Aziz Shaikh S, Denny E C, Kumarchandra R, Natarajan S, Sunny J, Shenoy N, K. P N. Evaluation of salivary tumor necrosis factor α as a diagnostic biomarker in oral submucosal fibrosis and squamous cell carcinoma of the oral cavity and oropharynx: a cross sectional observational study. Front Oral Health 2024; 5:1375162. [PMID: 38595736 PMCID: PMC11002162 DOI: 10.3389/froh.2024.1375162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Tumor necrosis factor α (TNF-α) is known to be associated with chronic inflammation, and its expression has been shown to increase in advanced cancers. Chronic inflammation is a characteristic feature of oral submucous fibrosis (OSMF), which is a potentially malignant disorder (PMD). Squamous cell carcinoma (SCC) is associated with considerable mortality and morbidity and an early detection or monitoring would greatly help in achieving an effective cure. TNF-α was thus evaluated for use as a biomarker in the present study according to the stage of OSMF and histological grade of SCC in the oral cavity and oropharynx. Methods This study included 45 patients divided into 3 groups-OSMF group, SCC group and control group-each comprising 15 participants. Saliva samples were collected from each patient, and salivary TNF-α levels were estimated using an ELISA kit. Results Statistical analysis revealed no significant differences in TNF-α levels among the OSMF, SCC and control groups; however, there was an increase in the salivary TNF-α level in patients with stage 3 disease according to the clinical stage of OSMF, for which the p value was 0.027. Discussion An increase in the TNF-α concentration with increasing clinical stage suggested a role for TNF-α in the spread of OSMF involvement in anatomical structures of the oral cavity and oropharynx. No significant difference in salivary TNF-α levels was noted among the OSMF, SCC and control groups. Conclusion The study showed a positive correlation of TNF-α with increasing stages of OSMF but was not a reliable biomarker in the categorization of the same.
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Affiliation(s)
- Sabiha Abdul Aziz Shaikh
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ceena Denny E
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Reshma Kumarchandra
- Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Srikant Natarajan
- Department of Oral and Maxillofacial Pathology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Johan Sunny
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nandita Shenoy
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nandita K. P
- Department of Oral and Maxillofacial Pathology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Contrera KJ, Patel MR, Burtness B, Mehra R, Ferris RL. The role of surgery and deescalation for HPV-related oropharyngeal cancer. Cancer 2024. [PMID: 38497569 DOI: 10.1002/cncr.35287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Recently published and ongoing trials are helping to define the role of transoral robotic surgery for oropharyngeal cancer. Evidence to date supports the use of surgery as a valuable tool in the multidisciplinary deescalation of low-risk human papillomavirus-related oropharyngeal squamous cell carcinoma.
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Affiliation(s)
| | - Mihir R Patel
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Barbara Burtness
- Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut, USA
| | - Ranee Mehra
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
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Divakar P, Kim SS, Kerr DA, Pettus JR, Paydarfar JA. The art of specimen orientation: Two-dimensional maps for oropharynx squamous cell carcinoma. Head Neck 2024; 46:702-707. [PMID: 38116698 DOI: 10.1002/hed.27613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
The goal of surgical treatment for oropharynx squamous cell carcinoma (SCCa) is resection to negative margins. Current methods of orienting resection specimens often do not give a comprehensive view, especially in oropharynx SCCa where specimens can lack anatomic landmarks. We created standardized two-dimensional maps of oropharynx anatomy drawn to scale to improve communication between surgeons and pathologists. Notes regarding surgery including anatomic landmarks, areas of concern, additional margins, and relevant clinical information were added to the map. The maps guided pathology work-up, and the pathologist could communicate details back to the surgeon on how the specimen was sectioned or locations of microscopic foci to direct future treatment and clinical monitoring. The use of two-dimensional maps for oropharynx SCCa specimens offers a standardized solution to address the challenges of anatomic orientation. These maps summarized key pathological information, preserved clinical details from the specimens, and guided multidisciplinary conferences when planning adjuvant treatment.
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Affiliation(s)
- Prashanthi Divakar
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Stephanie S Kim
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jason R Pettus
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joseph A Paydarfar
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Yuvnik T, Chia L, Laura OC, Tieu TT, Mahesh K, Bradley B, Daron C, Chris W. Differences in geometric patterns of failure in human papillomavirus (HPV)-associated and HPV-non-associated oropharyngeal cancer after definitive radiotherapy. Head Neck 2024; 46:552-560. [PMID: 38108534 DOI: 10.1002/hed.27606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate and compare the spatial pattern of locoregional recurrences in patients diagnosed with HPV-associated and HPV-non-associated oropharyngeal SCC (OPSCC) treated with definitive radiotherapy. METHODS AND MATERIALS Patients who had locoregional recurrence following definitive intensity-modulated radiation therapy were identified at a single tertiary institution. Target volumes were delineated according to the latest consensus international guidelines. Recurrences were classified into five categories based on radiotherapy dose distribution and target volume, using a previously validated methodology; type A (central high dose), type B (peripheral high dose), type C (central elective dose), type D (peripheral elective dose), and type E (extraneous dose). The types of failure were compared between p16-positive and p16-negative tumors using the Pearson chi-square test. RESULTS Fifty-eight locoregional recurrences were observed in 36 patients. The majority of recurrences were in nodal locations (66%, 38/58). Among these, 34 (59%) were classified as type A, 6 (10%) as type B, 9 (15%) as type C, 5 (9%) as type D, and 4 (7%) as type E failure. A significant difference was found in the types of failure between p16-positive and p16-negative tumors (X2 9.52, p = 0.044). p16-negative tumors were more likely to have recurrences in a peripheral location compared to p16-positive tumors (32% vs. 7%). p16-positive tumor were more likely to have extraneous recurrences (17% vs. 0%). CONCLUSION Our study results identified a significant difference in patterns of locoregional failure among patients diagnosed with oropharyngeal cancer following consensus-based tumor delineation and modern radiotherapy. Further confirmatory pattern of failure studies are required to enable greater individualization of radiotherapy for patients diagnosed with oropharyngeal malignancy in the future.
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Affiliation(s)
- Trada Yuvnik
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - Low Chia
- Canberra Region Cancer Centre, Garran, Australian Capital Territory, Australia
| | - O' Connor Laura
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Tieu Thi Tieu
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Kumar Mahesh
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Beeksma Bradley
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Cope Daron
- University of Newcastle, Newcastle, New South Wales, Australia
- John Hunter Hospital - Surgical Services, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Wratten Chris
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
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13
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Maza G, Sharma A. Topical Hemostatic Agents and Risk of Postoperative Hemorrhage After Transoral Robotic Surgery. Ear Nose Throat J 2024:1455613241233097. [PMID: 38380626 DOI: 10.1177/01455613241233097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Objective: Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS). The available research literature on topical hemostatic agents is deficient, despite their wide use. This study aims to evaluate the frequency and severity of hemorrhagic events after TORS procedures, performed with various topical hemostatic agents. Methods: This study was planned as a retrospective review to identify postoperative hemorrhage events in a database of all consecutive adult patients who required TORS from January 1, 2015, to April 1, 2020. All procedures were performed in one single institution by the same surgeon. In 2017, bovine gelatin matrix with thrombin (BgMT) was replaced by the porcine gelatin matrix with thrombin (PgMT) for all procedures. Postoperative hemorrhage was identified, along with hemostatic agents employed and other variables. Results: A cohort of 80 TORS procedures was obtained from a population of 78 individuals (60 males:18 females). BgMT was used in 28 procedures (35%), and five cases of postoperative hemorrhage were identified (17.8%), two of them were severe. PgMT was used in 52 procedures (65%) just observing one minor hemorrhagic event (1.92%). Although a significant difference was observed for total events between groups (P = .0183), there was no difference between major or severe hemorrhagic events (P = .1196). The overall rate of major and severe postoperative hemorrhage in the study population was 2.5% (n = 80). Conclusions: This is the first study to evaluate topical hemostatic agents during TORS procedures. The PgMT group had a reduced incidence of total postoperative hemorrhages, although there was no difference in the number of severe hemorrhagic events. The overall simplicity and cost-effectiveness of these agents would support their use, particularly considering the potential risk associated with airway hemorrhage.
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Affiliation(s)
- Guillermo Maza
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
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14
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Brunkhorst H, Schnellhardt S, Büttner-Herold M, Daniel C, Fietkau R, Distel LV. Neutrophils in HNSCC Can Be Associated with Both a Worse or Favorable Prognosis. Biomolecules 2024; 14:205. [PMID: 38397442 PMCID: PMC10886850 DOI: 10.3390/biom14020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The prognostic significance of tumor-infiltrating neutrophils in head and neck squamous cell carcinoma (HNSCC) is poorly understood. It is unclear how the presence of neutrophils affects prognosis due to their polarization into cytotoxic N1 or immunosuppressive N2. Therefore, we determined the number of CD66b+ neutrophil granulocytes separately in the stromal and epithelial compartments in cancer tissues from 397 patients with HNSCC. Tumor samples from six historical patient groups were processed into tissue microarrays and stained immunohistochemically. In total, 21.9% were HPV positive (p16+). Neutrophil counts were much lower in the stromal compartment (372 ± 812) than in the epithelial cancer compartment (1040 ± 1477) (p < 0.001), with large differences between groups. In three groups with high neutrophil infiltration, high rates were associated with a favorable prognosis, whereas in two groups, high rates were a negative prognostic factor. In p16- oropharyngeal and hypopharyngeal cancer high infiltration was associated with a favorable prognosis. Cancers with an exclusion of neutrophils in the epithelial compartment were associated with improved prognosis. In oropharyngeal and hypopharyngeal HPV-negative cancer high neutrophil infiltration rates were clearly associated with prolonged survival. Neutrophil granulocytes in HNSCC may contribute to a favorable or unfavorable prognosis.
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Affiliation(s)
- Hendrik Brunkhorst
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Sören Schnellhardt
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Christoph Daniel
- Department of Nephropathology, Institute of Pathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Luitpold V. Distel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
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15
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Key S, Chia C, Magarey M, Dixon B. Risk of malignancy in incidental oropharyngeal lesions exhibiting fluorodeoxyglucose uptake which proceed to tissue biopsy. ANZ J Surg 2024; 94:122-127. [PMID: 38115646 DOI: 10.1111/ans.18839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Utilization of positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose is increasing in use for a variety of indications, including surveillance of cancer patients. There is a paucity of evidence pertaining to the significance of incidental PET-avid oropharyngeal lesions. This study aims to examine the clinical and radiological features of these incidental oropharyngeal lesions in patients undergoing PET for indications other than head and neck cancer. METHODS Retrospective cohort study of three Australian tertiary hospitals, from 2015 to 2021, on adult patients undergoing biopsy of incidental PET-avid oropharyngeal lesions. Primary outcome of interest was the incidence of malignancy. Patients with a previous history of, or undergoing investigations for, head and neck cancer were excluded. RESULTS Thirty-one patients were included, wherein 21 patients had tonsillar uptake, and 13 patients had base of tongue uptake. Tonsillar disease was mostly asymmetrical (n = 15/21), bilateral (n = 11/21), and had median SUVmax 9.35 (n = 12, IQR 7.4-11.15). Base of tongue was mostly asymmetrical (n = 7/13, 54%), bilateral (n = 8/13, 62%), and had median SUVmax 8.2 (n = 10, IQR 6.9-12.65). Seven patients had malignancy confirmed on tissue biopsy: five biopsies confirmed the tissue diagnosis of suspected lymphoma, and two incidental findings of unexpected malignancies: one p16 positive tonsillar squamous cell carcinoma, and one metastatic breast cancer. CONCLUSION In 31 patients undergoing tissue biopsy for incidental PET-avid oropharyngeal lesions, there were two unexpected malignancies. Our study results indicate that although unexpected malignancies are uncommon, a malignant diagnosis cannot be excluded from clinical features alone.
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Affiliation(s)
- Seraphina Key
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Clemente Chia
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Matthew Magarey
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Pinnacle Surgery, Epworth Hospital, Richmond, Victoria, Australia
- Department of Medical Education, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Dixon
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Pinnacle Surgery, Epworth Hospital, Richmond, Victoria, Australia
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16
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Giotakis AI, Giotakis EI, Kyrodimos E. The Value of the Endoscope-Holding Arm in Transoral Pharyngeal Surgery. J Clin Med 2024; 13:507. [PMID: 38256641 PMCID: PMC10816363 DOI: 10.3390/jcm13020507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Transoral pharyngeal surgery is mainly feasible with the use of a microscope or robotic systems. Data about alternative methods, with lower costs and easier availability, are sparse. We intended to examine to what extent the endoscope-holding arm is a suitable alternative to the microscope or robotic systems. MATERIAL AND METHODS We retrospectively reviewed subjects who underwent pharyngeal tumor resection with the endoscope-holding arm in our university department. RESULTS We identified 13 subjects who underwent transoral pharyngeal surgery between November 2020 and November 2023. Most subjects presented with an oropharyngeal tumor (6/11 in the lateral wall or tonsil; 4/11 in the tongue base). The oropharyngeal lateral wall or tonsillar tumors were exposed with a standard mouth gag. The tongue-base tumors or hypopharyngeal tumors were exposed with an operating laryngoscope. Advantages over the microscope included an angled view. Advantages over robotic systems included haptic feedback and a faster setup. Advantages over both the microscope and robotic systems included lower costs and easier availability. Visualization with the endoscope was sufficient and similar to that of the microscope. Bimanual action was possible with surgical forceps and a monopolar electrode. CONCLUSIONS Transoral pharyngeal surgery was feasible with the endoscope-holding arm. The endoscope-holding arm could be a cost-efficient alternative to the microscope or robotic systems.
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Affiliation(s)
- Aris I. Giotakis
- First Department of Otorhinolaryngology, Hippocrateion General Hospital, 115 27 Athens, Greece; (E.I.G.); (E.K.)
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17
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Dwivedi A, Raza MW, Prasad SN, Singh A. Prospective Study to Compare Efficacy of Conventional Chemoradiotherapy with Hypofractionated Chemoradiotherapy in Locally Advanced Carcinoma of Oropharynx. Asian Pac J Cancer Prev 2023; 24:4077-4083. [PMID: 38156840 PMCID: PMC10909098 DOI: 10.31557/apjcp.2023.24.12.4077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
AIMS Chemoradiotherapy is the standard treatment for advanced Oropharyngeal squamous cell carcinoma (OPSCC). Upcoming hypofractionation has led to better compliance and non-inferior results in various sites such as breast and prostate cancer etc. This study prospectively compared a dose-intensified schedule in advanced OPSCC with standard hypofractionation. MATERIALS AND METHODS Patients with advanced stage III and IV OPSCC suitable for radical chemoradiotherapy were eligible. Patients were alternatively allocated to both the treatment arms. Arm A planned to receive 64 Gy in 25 fractions (#) with concurrent cisplatin and Arm B received standard fractionation 70 Gy in 35 # with concurrent cisplatin. All patients completed a median follow up of 6 to 18 months. The primary end point was acute toxicity (less than 3 months) and late toxicity at 1 year. Secondary end point was disease free survival and overall survival at 1 year. RESULTS 44 patients in arm A and 49 patients in arm B were recruited over 18 months. 34 patients completed full-dose radiotherapy in both arms. Maximum acute toxicity in arm A in terms of skin reaction was Grade II in 47.05% cases and mucositis grade II in 67.6% cases. In arm B grade II skin toxicity was seen in 47.1% and mucositis grade II was seen in 79.4 % cases. Ryle's tube dependency was seen in 38.2 % cases in arm A and 50% in arm B. Complete response rate at 3 months was equivalent in both arms in Arm A (100%), and in Arm B (96.7%). Disease free survival (DFS), Overall survival (OS) at 3 month, 6 months, and 12 months was comparable. CONCLUSIONS 64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with equivalent results and better compliance. Shorter fractionation schedule is more acceptable and we look forward for more randomized control trials.
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Affiliation(s)
| | - Mohd Waseem Raza
- Department of Radiation Oncology, J.K Cancer Institute, Kanpur, India.
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18
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Virós Porcuna D, Viña Soria C, Vila Poyatos J, Palau Viarnès M, Malagon López P, Gonzàlez Lluch C, Higueras Suñe C, Pollán Guisasola CM, Carrasco López C. Oropharyngeal free flap reconstruction: Transoral robotic surgery versus open approach. Laryngoscope Investig Otolaryngol 2023; 8:1564-1570. [PMID: 38130254 PMCID: PMC10731478 DOI: 10.1002/lio2.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/22/2023] [Accepted: 10/15/2023] [Indexed: 12/23/2023] Open
Abstract
Objective Transoral robotic surgery (TORS) has evolved since its 2009 US Food and Drug Administration approval for use in local stage T1-T2 oropharyngeal carcinoma. The ability to resect increasingly larger and more complex lesions has led to the need to introduce reconstructive techniques through this route, avoiding the classic transmandibular or pull-through approach. Few studies have compared the safety, efficacy, and advantages of TORS versus classic open approaches in oropharyngeal salvage surgery with reconstruction using microanastomosed flaps. Here we retrospectively compare our center's experience with the open approach and TORS and describe the technical variations used. Methods Between 2013 and 2021, 30 stage III-IV oropharyngeal cancer patients underwent salvage surgery with reconstruction in our center. From 2013 to 2017, 15 patients underwent surgery with the classic open approach, and from 2018 to 2021, an additional 15 patients underwent TORS. We have compared surgical outcomes, post-surgical results, and survival in the two groups. Results Patient characteristics were similar in the two groups. TORS was associated with shorter surgical time (p < .001), fewer complications (p = .01), shorter hospital stay (p < .001), and lower feeding tube requirements (p = .003). No significant differences were observed between the two groups in the free margin rate or survival. Conclusion Oropharyngeal salvage surgery with TORS with free flap reconstruction reduced associated morbidity compared to the open approach in a patient cohort with poor prognosis. Level of Evidence 4.
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Affiliation(s)
- David Virós Porcuna
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
| | - Constanza Viña Soria
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
| | - Jordi Vila Poyatos
- Plastic and Reconstructive Surgery DepartmentHospital Germans Trias i PujolBadalonaSpain
| | - Mar Palau Viarnès
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
| | - Paloma Malagon López
- Plastic and Reconstructive Surgery DepartmentHospital Germans Trias i PujolBadalonaSpain
| | - Carlota Gonzàlez Lluch
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
| | - Carmen Higueras Suñe
- Plastic and Reconstructive Surgery DepartmentHospital Germans Trias i PujolBadalonaSpain
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19
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Dahal P, Parajuli S. Hashimoto thyroiditis in a lingual thyroid: An interesting case. Clin Case Rep 2023; 11:e8273. [PMID: 38033679 PMCID: PMC10683035 DOI: 10.1002/ccr3.8273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023] Open
Abstract
Key Clinical Message Whenever an enlarging mass is seen in throat, possibility of lingual thyroid should be considered. Thyroid function test should be done whenever ectopic thyroid is detected. Imaging (ultrasonography or Tc-99m scintigraphy) is adequate for diagnosis. Conservative treatment with levothyroxine helps in reducing size of lingual thyroid. Abstract Hashimoto thyroiditis in lingual thyroid results in enlargement of the thyroid gland and oropharyngeal symptoms. Suppression therapy with levothyroxine results in reduction in size of the gland. We present an interesting case of Hashimoto disease in an adolescent female presenting as oropharyngeal mass.
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Affiliation(s)
- Prajwal Dahal
- Department of Radiology and ImagingGrande International HospitalKathmanduNepal
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20
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Gaspari V, Djusse ME, Morselli S, Rapparini L, Foschi C, Ambretti S, Lazzarotto T, Piraccini BM, Marangoni A. Non-pathogenic Neisseria species of the oropharynx as a reservoir of antimicrobial resistance: a cross-sectional study. Front Cell Infect Microbiol 2023; 13:1308550. [PMID: 38076458 PMCID: PMC10703147 DOI: 10.3389/fcimb.2023.1308550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
Commensal Neisseria species of the oropharynx represent a significant reservoir of antimicrobial resistance determinants that can be transferred to Neisseria gonorrhoeae. This aspect is particularly crucial in 'men having sex with men' (MSM), a key population in which pharyngeal co-colonization by N. gonorrhoeae and non-pathogenic Neisseria species is frequent and associated with the emergence of antimicrobial resistance. Here, we explored the antimicrobial susceptibility of a large panel of non-pathogenic Neisseria species isolated from the oropharynx of two populations: a group of MSM attending a 'sexually transmitted infection' clinic in Bologna (Italy) (n=108) and a group of males representing a 'general population' (n=119). We collected 246 strains, mainly belonging to N. subflava (60%) and N. flavescens (28%) species. Their antimicrobial susceptibility was evaluated assessing the minimum inhibitory concentrations (MICs) for azithromycin, ciprofloxacin, cefotaxime, and ceftriaxone using E-test strips. Overall, commensal Neisseria spp. showed high rates of resistance to azithromycin (90%; median MICs: 4.0 mg/L), and ciprofloxacin (58%; median MICs: 0.12 mg/L), whereas resistance to cephalosporins was far less common (<15%). Neisseria strains from MSM were found to have significantly higher MICs for azithromycin (p=0.0001) and ciprofloxacin (p<0.0001) compared to those from the general population. However, there was no significant difference in cephalosporin MICs between the two groups. The surveillance of the antimicrobial resistance of non-pathogenic Neisseria spp. could be instrumental in predicting the risk of the spread of multi-drug resistant gonorrhea. This information could be an early predictor of an excessive use of antimicrobials, paving the way to innovative screening and prevention policies.
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Affiliation(s)
- Valeria Gaspari
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marielle Ezekielle Djusse
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Sara Morselli
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luca Rapparini
- Section of Dermatology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Claudio Foschi
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Microbiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Ambretti
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Microbiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Microbiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Section of Dermatology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Antonella Marangoni
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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21
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Bourumeau W, Tremblay K, Jourdan G, Girard C, Laprise C. Bacterial Biomarkers of the Oropharyngeal and Oral Cavity during SARS-CoV-2 Infection. Microorganisms 2023; 11:2703. [PMID: 38004715 PMCID: PMC10673573 DOI: 10.3390/microorganisms11112703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Individuals with COVID-19 display different forms of disease severity and the upper respiratory tract microbiome has been suggested to play a crucial role in the development of its symptoms. (2) Methods: The present study analyzed the microbial profiles of the oral cavity and oropharynx of 182 COVID-19 patients compared to 75 unaffected individuals. The samples were obtained from gargle screening samples. 16S rRNA amplicon sequencing was applied to analyze the samples. (3) Results: The present study shows that SARS-CoV-2 infection induced significant differences in bacterial community assemblages, with Prevotella and Veillonella as biomarkers for positive-tested people and Streptococcus and Actinomyces for negative-tested people. It also suggests a state of dysbiosis on the part of the infected individuals due to significant differences in the bacterial community in favor of a microbiome richer in opportunistic pathogens. (4) Conclusions: SARS-CoV-2 infection induces dysbiosis in the upper respiratory tract. The identification of these opportunistic pathogenic biomarkers could be a new screening and prevention tool for people with prior dysbiosis.
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Affiliation(s)
- William Bourumeau
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada; (W.B.); (C.G.)
- Centre Intersectoriel en Santé Durable, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada;
| | - Karine Tremblay
- Pharmacology-Physiology Department, Université de Sherbrooke, Saguenay, QC J1K 2R1, Canada;
- Research Centre of Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay–Lac-Saint-Jean (CIUSSS-SLSJ), Saguenay, QC G7H 7K9, Canada
| | - Guillaume Jourdan
- Centre Intersectoriel en Santé Durable, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada;
| | - Catherine Girard
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada; (W.B.); (C.G.)
- Centre Intersectoriel en Santé Durable, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada;
| | - Catherine Laprise
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada; (W.B.); (C.G.)
- Centre Intersectoriel en Santé Durable, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada;
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22
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Nikkilä R, Tolonen S, Salo T, Carpén T, Pukkala E, Mäkitie A. Occupational Etiology of Oropharyngeal Cancer: A Literature Review. Int J Environ Res Public Health 2023; 20:7020. [PMID: 37947576 PMCID: PMC10647348 DOI: 10.3390/ijerph20217020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
While abundant evidence exists linking alcohol, tobacco, and HPV infection to a carcinogenic impact on the oropharynx, the contribution of inhalational workplace hazards remains ill-defined. We aim to determine whether the literature reveals occupational environments at a higher-than-average risk of developing oropharyngeal cancer (OPC) and summarize the available data. To identify studies assessing the relationship between occupational exposure and risk of OPC, a search of the literature through the PubMed-NCBI database was carried out and, ultimately, 15 original articles meeting eligibility criteria were selected. Only original articles in English focusing on the association between occupational exposure and risk or death of specifically OPC were included. The available data are supportive of a potentially increased risk of OPC in waiters, cooks and stewards, artistic workers, poultry and meat workers, mechanics, and World Trade Center responders exposed to dust. However, the available literature on occupation-related OPC is limited. To identify occupational categories at risk, large cohorts with long follow-ups are needed. Identification of causal associations with occupation-related factors would require dose-response analyses adequately adjusted for confounders.
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Affiliation(s)
- Rayan Nikkilä
- Department of Otorhinolaryngology—Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, FI-00139 Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, FI-00014 Helsinki, Finland
| | - Suvi Tolonen
- Department of Otorhinolaryngology—Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
| | - Tuula Salo
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, FI-00014 Helsinki, Finland
- Translational Immunology Research Program (TRIMM), University of Helsinki, FI-00014 Helsinki, Finland
- Research Unit of Population Health, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, FI-90220 Oulu, Finland
- Department of Pathology, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
| | - Timo Carpén
- Department of Otorhinolaryngology—Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, FI-00014 Helsinki, Finland
- Department of Pathology, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, FI-00139 Helsinki, Finland
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, FI-00014 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Hospital, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Patel SA, Gibson MK, Deal A, Sheth S, Heiling H, Johnson SM, Douglas K, Flores M, Blumberg J, Lumley C, Yarbrough WG, Shen C, Chera BS, Bauman JR, Hackman T, Weiss J. A phase 2 study of neoadjuvant chemotherapy plus durvalumab in resectable locally advanced head and neck squamous cell carcinoma. Cancer 2023; 129:3381-3389. [PMID: 37395170 DOI: 10.1002/cncr.34930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Patients with locally advanced head and neck squamous cell cancer (HNSCC) are treated with surgery followed by adjuvant (chemo) radiotherapy or definitive chemoradiation, but recurrence rates are high. Immune checkpoint blockade improves survival in patients with recurrent/metastatic HNSCC; however, the role of chemo-immunotherapy in the curative setting is not established. METHODS This phase 2, single-arm, multicenter study evaluated neoadjuvant chemo-immunotherapy with carboplatin, nab-paclitaxel, and durvalumab in patients with resectable locally advanced HNSCC. The primary end point was a hypothesized pathologic complete response rate of 50%. After chemo-immunotherapy and surgical resection, patients received study-defined, pathologic risk adapted adjuvant therapy consisting of either durvalumab alone (low risk), involved field radiation plus weekly cisplatin and durvalumab (intermediate risk), or standard chemoradiation plus durvalumab (high risk). RESULTS Between December 2017 and November 2021, 39 subjects were enrolled at three centers. Oral cavity was the most common primary site (69%). A total of 35 of 39 subjects underwent planned surgical resection; one subject had a delay in surgery due to treatment-related toxicity. The most common treatment-related adverse events were cytopenias, fatigue, and nausea. Post treatment imaging demonstrated an objective response rate of 57%. Pathologic complete response and major pathologic response were achieved in 29% and 49% of subjects who underwent planned surgery, respectively. The 1-year progression-free survival was 83.8% (95% confidence interval, 67.4%-92.4%). CONCLUSIONS Neoadjuvant carboplatin, nab-paclitaxel, and durvalumab before surgical resection of HNSCC were safe and feasible. Although the primary end point was not met, encouraging rates of pathologic complete response and clinical to pathologic downstaging were observed.
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Affiliation(s)
- Shetal A Patel
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael K Gibson
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center and the Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Allison Deal
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hillary Heiling
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven M Johnson
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathe Douglas
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Flores
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey Blumberg
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine Lumley
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wendell G Yarbrough
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Colette Shen
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bhishamjit S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica R Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Trevor Hackman
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jared Weiss
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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24
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Kwon MJ, Park HY, Lee JS, Kim ES, Kim NY, Nam ES, Cho SJ, Kang HS. Dysregulated microRNA Expression Relevant to TERT Promoter Mutations in Tonsil Cancer-A Pilot Study. Life (Basel) 2023; 13:2090. [PMID: 37895471 PMCID: PMC10608590 DOI: 10.3390/life13102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Tonsillar squamous cell carcinomas (TSCCs) exhibit high rates of human papillomavirus (HPV) positivity. The expression profiles of microRNA (miRNA), which are small RNA molecules that play pivotal roles in biological processes, in TSCC in relation to the HPV status and cancer-related genetic mutations are not well investigated. Herein, we expanded our previous research, which was focused on established clinicopathological and genetic mutational data, to profile miRNA expression in TSCC, aiming to identify clinically relevant targets for early diagnosis and therapeutic intervention. The miRNA profiles were analyzed using the nCounter Nanostring miRNA Expression assay in 22 surgically resected TSCC tissues and their contralateral normal tonsil tissues. The TERT promoter (TERTp) gene was the only relevant candidate gene associated with differentially expressed miRNAs in TSCC. Hierarchical clustering analysis revealed high expression levels of hsa-miR-1285-5p, hsa-miR-1203, hsa-miR-663a, hsa-miR-1303, hsa-miR-33a-5p, and hsa-miR-3615 coupled with low expression levels of hsa-miR-3182, hsa-miR-219a-2-3p, and hsa-miR-767-3p, which were associated with HPV-positive TSCC (p = 0.009). Functional enrichment analysis revealed that these dysregulated miRNAs tended to be involved in protein binding (molecular function) and cellular components (biological processes). Therefore, hsa-miR-1285-5p and hsa-miR-663a may be associated with HPV-positive TERTp-mutated tumors and may serve as potential treatment targets and biomarkers for early detection.
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Affiliation(s)
- Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea;
| | - Joong Seob Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea;
| | - Eun Sook Nam
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea; (E.S.N.); (S.J.C.)
| | - Seong Jin Cho
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea; (E.S.N.); (S.J.C.)
| | - Ho Suk Kang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
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Poonthottathil F, Suresh S, Nayer J, Aggarwal P. Diagnostic accuracy of drooling, reluctance, oropharynx, others, and leukocytosis score as a predictor of mortality and complications following acute corrosive ingestion. Turk J Emerg Med 2023; 23:225-231. [PMID: 38024188 PMCID: PMC10664197 DOI: 10.4103/tjem.tjem_128_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/01/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Esophagogastroduodenoscopy is considered the gold standard in assessing the severity of injury to the gastrointestinal tract following corrosive ingestion. Zargar's endoscopic grading of injury helps in prognostication as well as guiding management. Since the major burden of cases lies in resource-limited settings, the availability of endoscopic evaluation is a limiting factor. Hence, it is prudent to develop bedside tools that can be used as screening tools to identify patients at high risk of mortality and complications so that timely referrals and judicious utilization of resources can be made. Literature in this regard is limited and published studies have shown that clinical features fail to predict the severity of injury. We aimed our study to find the role of Drooling, Reluctance, Oropharynx, Others, and Leukocytosis (DROOL) score as a predictor of mortality and complications following acute corrosive ingestion. METHODS This was a diagnostic accuracy study conducted in the emergency department (ED) of a tertiary care hospital in North India. We screened all cases of acute corrosive ingestion presented to our ED. We collected the data on demographic profile, clinical features, investigations, endoscopy findings, treatment, and DROOL score. We followed patients for up to 12 weeks for outcomes including mortality and complications. RESULTS We studied 79 patients of acute corrosive ingestion. The median age was 26 years with a female predominance. Nausea, vomiting, and pain abdomen were the common symptoms. The median DROOL score was 4. The majority of our patients had normal to Zargar grade 1 injury to the stomach and esophagus. Out of 79 patients, 27 patients developed some complications. The overall mortality up to 12 weeks was 10%. The receiver operating characteristics (ROC) analysis was performed, and the area under the ROC (AUROC) curve of Zargar classification in predicting overall complications was 0.909 (96% confidence interval [CI]: 0.842-0.975) and it was 0.775 (95% CI: 0.553-1.000) in predicting mortality. The AUROC of DROOL score in predicting overall complications was 0.932 (95% CI: 0.877-0.987) and the AUROC of DROOL score in predicting mortality was 0.864 (95% CI: 0.758-0.970). The ROC analysis showed that a DROOL score ≤4 has a sensitivity of 96.2% and a specificity of 77.8% in predicting overall complications. Similarly, DROOL score ≤5 has a sensitivity of 81.7% and a specificity of 62.5% in predicting the development of mortality. Delong test showed that there was no statistically significant difference in Zargar versus DROOL score in terms of prediction of mortality and overall complications (P > 0.05). CONCLUSION DROOL score is comparable to Zargar score in identifying patients at high risk of mortality and complications. Hence, DROOL score can be used for risk stratification of patients presenting with corrosive ingestion.
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Affiliation(s)
- Fawaz Poonthottathil
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Soorya Suresh
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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26
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Mahdy MAA, Mohamed SA, Abdalla KEH. Morphology of the soft palate and palatine tonsil of the goat (Capra hyricus). Microsc Res Tech 2023; 86:1091-1098. [PMID: 37191111 DOI: 10.1002/jemt.24346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/04/2023] [Accepted: 05/06/2023] [Indexed: 05/17/2023]
Abstract
The present study was carried out to study the morphology of the goat's soft palate and palatine tonsil by gross anatomy, morphometry, light and scanning electron microscopy (SEM). Twelve heads of normal adult (18-24 months) apparently healthy goats of both sexes were collected from local commercial slaughterhouses in Qena Governorate, Egypt. The oral cavity was dissected, and samples were collected for both light and SEM. The soft palate of the goat formed the caudal continuation of the hard palate. It was relatively short, it extended from the level of the caudal border of the last upper molar tooth to terminate caudally against the base of the epiglottis. The oral mucous membrane of the soft palate was covered by non-keratinized stratified squamous epithelium. The lamina propria and submucosa contained connective tissue fibers, diffuse and nodular lymphatic tissue, striated muscle fibers, and a large number of mucous and serous palatine glands. By SEM, the ventral surface had several rounded openings occupied by flower-like structures. These openings represented the entrances to the palatine glands. The palatine tonsil was large and protruded from a fossa in the lateral wall of the oropharynx. It had 2-3 elongated irregular openings that lead to the underlying crypts. These crypts were well-developed and lined by non-keratinized stratified squamous epithelium. The epithelium of the tonsillar crypts directly covered lymphoid tissue and was infiltrated by lymphocytes. Tonsillar glands of pure mucous type were demonstrated. In conclusion, the study provides the basic morphological features of soft palate, as well as the palatine tonsil of the goat by gross observation, light and SEM. The palatine tonsils of goat were well-developed with extensive crypt system, suggesting their essential role in the immunological response against antigens that enter through the oral cavity. The current findings may be useful to understand the role of the palatine tonsil in immunity and disease pathogenesis. RESEARCH HIGHLIGHTS: The study reported the basic morphological features of soft palate and palatine tonsil of goat. The ventral surface of the soft palate had several rounded openings occupied by flower-like structures. The palatine tonsils of goat were well-developed with extensive crypt system. The findings might help to understand the role of the palatine tonsil in immunity and disease pathogenesis.
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Affiliation(s)
- Mohamed A A Mahdy
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
- Department of Anatomy and Histology, Faculty of Veterinary Medicine, King Salman International University, Ras Sudr, Egypt
| | - Salma A Mohamed
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Kamal E H Abdalla
- Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
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27
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Prétet JL, Baraquin A, Barret AS, Bercot B, Rahib D, Lydié N, Pépin-Puget L, Lepiller Q. Anal and oropharyngeal HPV distribution in HIV-negative multipartner MSM using self-sampling kits for HIV and sexually transmitted infection screening. J Med Virol 2023; 95:e29068. [PMID: 37654019 DOI: 10.1002/jmv.29068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/28/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
Men who have sex with men (MSM) are at high risk of sexually transmitted infections, among which HPV infections are particularly prominent. We took advantage of the MémoDépistages study to evaluate HPV distribution at anal and oropharyngeal sites in HIV-negative multipartner MSM. HPV DNA was detected in 82% (n = 344) of anal and 11% (n = 45) of oropharyngeal self-collected samples taken from 421 participants. Multiple HPV types were detected in 70% of anal samples, and single HPV types in 91% of oropharyngeal samples. HPV16 was the most frequent type detected in the anus, followed by HPV6, HPV51, and HPV52. HPV6, HPV16, and HPV11 were the most prevalent types in the oropharynx. HPV targeted by the nonavalent vaccine was detected in 71% and 50% of HPV-positive anal and oropharyngeal samples, respectively. The main risk factor associated with HPV detection was frequenting gay meeting places, living in large cities, and having an anal Chlamydia trachomatis/Neisseria gonorrhoeae infection. In this cohort of highly sexually active MSM, HPV detection was highly frequent and rendered them at high risk of precancerous and cancerous lesions. Universal vaccination against HPV before sexual debut is an important public health strategy to prevent HPV-associated cancers in this highly vulnerable population of HIV-negative MSM.
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Affiliation(s)
- Jean-Luc Prétet
- Université de Franche-Comté, Carcinogenèse associée aux HPV, Besançon, France
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
| | - Alice Baraquin
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
| | | | - Béatrice Bercot
- Laboratoire associé au Centre National de Référence des IST bactériennes, Service de Bactériologie, Hôpital St Louis, APHP, Paris, France
- Université Paris Cité, IAME UMR1137, Paris, France
| | | | | | - Line Pépin-Puget
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
| | - Quentin Lepiller
- Université de Franche-Comté, Carcinogenèse associée aux HPV, Besançon, France
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
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28
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Merenstein C, Fitzgerald AS, Khatib LA, Graham-Wooten J, Bushman FD, Collman RG. Effects of Mask Reuse on the Oropharyngeal, Skin, and Mask Microbiome. J Infect Dis 2023; 228:479-486. [PMID: 37217829 PMCID: PMC10428194 DOI: 10.1093/infdis/jiad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Face masks have been critical in the coronavirus disease 2019 (COVID-19) pandemic, but supplies were sometimes limited and disposable masks contribute greatly to environmental waste. Studies suggest that filtration capacity is retained with repeated use, and surveys indicate many people reuse surgical masks. However, the impact of mask reuse on the host is understudied. METHODS We applied 16S rRNA gene sequencing to investigate the bacterial microbiome of the facial skin and oropharynx of individuals randomized to wearing fresh surgical masks daily versus masks reused for 1 week. RESULTS Compared to daily fresh masks, reuse was associated with increased richness (number of taxa) of the skin microbiome and trend towards greater diversity, but no difference in the oropharyngeal microbiome. Used masks had either skin-dominant or oropharynx-dominant bacterial sequences, and reused masks had >100-fold higher bacterial content but no change in composition compared to those used for 1 day. CONCLUSIONS One week of mask reuse increased the number of low-abundance taxa on the face but did not impact the upper respiratory microbiome. Thus, face mask reuse has little impact on the host microbiome, although whether minor changes to the skin microbiome might relate to reported skin sequelae of masking (maskne) remains to be determined.
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Affiliation(s)
- Carter Merenstein
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ayannah S Fitzgerald
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Layla A Khatib
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jevon Graham-Wooten
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frederic D Bushman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronald G Collman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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29
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Maeso Riera J, Tarroch Sarasa X, Lao Luque J, Palomino Meneses L. Neuroendocrine Neoplasms of the Head and Neck: A Case Report on an Oropharyngeal Presentation. Cureus 2023; 15:e39823. [PMID: 37397684 PMCID: PMC10314709 DOI: 10.7759/cureus.39823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors that can appear in many different locations as neuroendocrine cells are distributed throughout the anatomy during embryonic development. This paper presents a case report of a 77-year-old woman with a rare NEN in the lateral wall of the pharynx. In addition to being very infrequent, it can be considered a second metachronous tumor since it is unrelated to a previous sinonasal NEN that the patient presented with 20 years before. We have reviewed the histological characteristics of NENs and the grading system used to determine their potential for metastasis or local invasion. NENs in the oropharynx are very infrequent and typically do not present systemic symptoms or specific local signs. The article concludes that surgical excision is typically the preferred treatment for localized NENs where complete removal is possible.
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Affiliation(s)
- Josep Maeso Riera
- Otolaryngology, Head and Neck Surgery, Sanitas CIMA Hospital, Barcelona, ESP
- Otolaryngology, Head and Neck Surgery, Hospital Universitari Mutua Terrassa, Terrassa, ESP
| | | | - Javier Lao Luque
- Otolaryngology, Head and Neck Surgery, Hospital Universitari Mutua Terrassa, Terrassa, ESP
| | - Laura Palomino Meneses
- Otolaryngology, Head and Neck Surgery, Hospital Universitari Mutua Terrassa, Terrassa, ESP
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30
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Carvajal LJ, Shing JZ, Vanegas JC, González E, Guillén D, Sierra MS, Hildesheim A, Porras C, Herrero R, Torres G, Shiels MS, Calderón A, Kreimer AR. Trends in incidence rates of head and neck squamous cell carcinomas overall and by potential relatedness to human papillomavirus, Costa Rica 2006 to 2015. Int J Cancer 2023; 152:2052-2060. [PMID: 36650690 DOI: 10.1002/ijc.34437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023]
Abstract
In Costa Rica (CR), only one report on head and neck cancer (HNC) incidence trends (1985-2007) has been published and no investigations on the epidemiology of potentially human papillomavirus (HPV)-related and HPV-unrelated HNCs have been done. We examined the age-standardized incidence rates (IRs) and trends of head and neck squamous cell carcinomas (HNSCC) and compared incidence trends of potentially HPV-related and HPV-unrelated HNSCCs. We obtained all available HNC cases for the period 2006-2015 from the Costa Rican National Cancer Registry of Tumors and the population estimates from the Costa Rican National Institute of Statistics and Census. The analysis was restricted to invasive HNSCCs (n = 1577). IRs and incidence rate ratios were calculated using SEER*Stat software and were age-standardized for the 2010 Costa Rican population. Joinpoint regression analysis program was used to calculate trends and annual percent changes (APCs) in rates. For all HNSCCs, the age-standardized IR was 34.0/million person-years; 95% CI 32.4, 35.8. There was a significant decline in the incidence of nasopharyngeal cancer (APC: -5.9% per year; 95% CI -10.8, -0.7) and laryngeal cancer (APC: -5.4% per year; -9.2, 1.5). The incidence trends for hypopharyngeal, oropharyngeal and oral cavity cancers each remained stable over time. HNSCCs were categorized by their potential relatedness to HPV infection. Though the APCs were not statistically significant, IRs of potentially HPV-related HNSCCs trended upward, while HPV-unrelated HNSCCs trended downward. HNSCCs are uncommon in CR and decreased over time. We observed a divergent pattern of decreasing HPV-unrelated with increasing HPV-related HNSCCs that should be further informed by HPV genotyping tumor samples.
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Affiliation(s)
- Loretto J Carvajal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.,Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Jaimie Z Shing
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Juan C Vanegas
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Emmanuel González
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica.,Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Dr. Enrique Baltodano Briceño, Guanacaste, Costa Rica
| | - Diego Guillén
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica.,Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Max Peralta, Cartago, Costa Rica
| | - Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Guillermo Torres
- Ministerio de Salud, Registro Nacional de Tumores, San José, Costa Rica
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Alejandro Calderón
- Caja Costarricense de Seguro Social, Proyecto de Fortalecimiento de la Atención del Cáncer, San José, Costa Rica
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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31
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Lifsics A, Cistjakovs M, Sokolovska L, Deksnis R, Murovska M, Groma V. The Role of the p16 and p53 Tumor Suppressor Proteins and Viral HPV16 E6 and E7 Oncoproteins in the Assessment of Survival in Patients with Head and Neck Cancers Associated with Human Papillomavirus Infections. Cancers (Basel) 2023; 15:2722. [PMID: 37345059 DOI: 10.3390/cancers15102722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
The role of HPV in the survival prognosis of patients with head and neck squamous cell carcinoma, especially patients with laryngeal squamous cell carcinoma (LSCC) and hypopharyngeal squamous cell carcinoma (HPSCC), is still somewhat ambiguous. The present study aimed to explore the significance of tumor suppressor proteins and HPV16 E6 and E7 oncoproteins in the assessment of survival in patients with oropharyngeal squamous cell carcinoma (OPSCC), LSCC, and HPSCC associated with high-risk (HR-) and low-risk (LR-) HPV infections. By utilizing molecular and immunohistochemical investigations of HNSCC samples and patient data, univariate and multivariate survival analyses were conducted. The presence of HPV DNA (LR- and HR-HPV) was associated with a better 5-year OS and DSS for OPSCC and LSCC. The IHC overexpression of HPV16 E6 protein and p16 protein was associated with better survival in the univariate (for OPSCC) and multivariate (OPSCC and HPSCC) survival analyses. The overexpression of p53 was associated with better survival in OPSCC. HPV infection plays a significant role in the tumorigenesis of HNSCC, and the immunohistochemical assessment of HPV16 E6 protein expression should be interpreted as a useful prognostic marker for OPSCC and HPSCC.
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Affiliation(s)
- Andrejs Lifsics
- Department of Otorhinolaryngology, Riga Stradiņš University, Pilsoņu 13, LV-1002 Riga, Latvia
| | - Maksims Cistjakovs
- Institute of Microbiology and Virology, Riga Stradiņš University, Rātsupītes 5, LV-1067 Riga, Latvia
| | - Liba Sokolovska
- Institute of Microbiology and Virology, Riga Stradiņš University, Rātsupītes 5, LV-1067 Riga, Latvia
| | - Renars Deksnis
- Department of Otorhinolaryngology, Riga Stradiņš University, Pilsoņu 13, LV-1002 Riga, Latvia
| | - Modra Murovska
- Institute of Microbiology and Virology, Riga Stradiņš University, Rātsupītes 5, LV-1067 Riga, Latvia
| | - Valerija Groma
- Institute of Anatomy and Anthropology, Riga Stradiņš University, Kronvalda blvd 9, LV-1010 Riga, Latvia
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Lin Fracp P, Holloway L, Min Franzcr M, Lee Franzcr M, Fowler Franzcr A. Prognostic and predictive values of baseline and mid-treatment FDG-PET in oropharyngeal carcinoma treated with primary definitive (chemo)radiation and impact of HPV status: review of current literature and emerging roles. Radiother Oncol 2023; 184:109686. [PMID: 37142128 DOI: 10.1016/j.radonc.2023.109686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/16/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND PURPOSE This study provides a review of the literature assessing whether semiquantitative PET parameters acquired at baseline and/or during definitive (chemo)radiotherapy ("prePET" and "iPET") can predict survival outcomes in patients with oropharyngeal squamous cell carcinoma (OPC), and the impact of human papilloma virus (HPV) status. MATERIAL AND METHODS A literature search was carried out using PubMed and Embase between 2001 to 2021 in accordance with PRISMA. RESULTS The analysis included 22 FDG-PET/CT studies1-22, 19 pre-PET and 3 both pre-PET and iPET14,18,20,. The analysis involved 2646 patients, of which 1483 are HPV-positive (17 studies: 10 mixed and 7 HPV-positive only), 589 are HPV-negative, and 574 have unknown HPV status. Eighteen studies found significant correlations of survival outcomes with pre-PET parameters, most commonly primary or "Total" (combined primary and nodal) metabolic tumour volume and/or total lesional glycolysis. Two studies could not establish significant correlations and both employed SUVmax only. Two studies also could not establish significant correlations when taking into account of the HPV-positive population only. Because of the heterogeneity and lack of standardized methodology, no conclusions on optimal cut-off values can be drawn. Ten studies specifically evaluated HPV-positive patients: five showed positive correlation of pre-PET parameters and survival outcomes, but four of these studies did not include advanced T or N staging in multivariate analysis1,6,15,22, and two studies only showed positive correlations after excluding high risk patients with smoking history7 or adverse CT features22. Two studies found that prePET parameters predicted treatment outcomes only in HPV-negative but not HPV-positive patients10,16. Two studies found that iPET parameters could predict outcomes in HPV-positive patients but not prePET parameters14,18. CONCLUSION The current literature supports high pre-treatment metabolic burden prior to definitive (chemo)radiotherapy can predict poor treatment outcomes for HPV-negative OPC patients. Evidence is conflicting and currently does not support correlation in HPV-positive patients.
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Affiliation(s)
- Peter Lin Fracp
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia.
| | - Lois Holloway
- South Western Sydney Clinical School, University of New South Wales, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Myo Min Franzcr
- Department of Radiation Oncology, Sunshine Coast University Hospital, Queensland, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Queensland, Australia
| | - Mark Lee Franzcr
- South Western Sydney Clinical School, University of New South Wales, NSW, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
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Culié D, Schiappa R, Pace-Loscos T, Guelfucci B, Vergez S, Garrel R, Fakhry N, Dassonville O, Poissonnet G, Lallemant B, Sudaka A, Saada-Bouzid E, Benezery K, Temam S, Gorphe P, Chamorey E, Bozec A. Enteral Nutrition during Radiotherapy for Oropharyngeal Cancers: Prevalence and Prognostic Factors Based on HPV Status (A GETTEC Study). J Clin Med 2023; 12:jcm12093169. [PMID: 37176609 PMCID: PMC10179627 DOI: 10.3390/jcm12093169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Nutritional support during radiotherapy is crucial to tolerating and completing oropharyngeal squamous cell carcinoma (OPSCC) treatment. The impact of HPV status on nutritional support is debated. The objective was to evaluate the rate of Reactive Feeding Tube (RFT) use and determine its prognostic factors during definitive radiotherapy for OPSCC. All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. The impact of tumor p16 status on the risk of RFT was assessed through multivariate analyses. Among the 543 patients, 103 patients required an RFT (19.0%). The use of RFT differed between centers (5% to 32.4%). In multivariate analysis, only tongue base involvement and concurrent chemotherapy were significantly associated with RFT (OR = 2.18 and 3.7, respectively). Tongue base involvement and concomitant chemotherapy were prognostic factors for RFT. HPV status was not a prognostic factor for enteral nutrition during radiotherapy for OPSCC.
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Affiliation(s)
- Dorian Culié
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Renaud Schiappa
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Tanguy Pace-Loscos
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, 83100 Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, 31100 Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, 34295 Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance-Hospitals of Marseille, 13005 Marseille, France
| | - Olivier Dassonville
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
| | - Gilles Poissonnet
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, 30900 Nîmes, France
| | - Anne Sudaka
- Antoine Lacassagne Centre, Department of Pathology, Côte d'Azur University, 06000 Nice, France
| | - Esma Saada-Bouzid
- Antoine Lacassagne Centre, Department of Medical Oncology, Côte d'Azur University, 06000 Nice, France
| | - Karen Benezery
- Antoine Lacassagne Centre, Department of Radiotherapy, Côte d'Azur University, 06000 Nice, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, 94805 Villejuif, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, 94805 Villejuif, France
| | - Emmanuel Chamorey
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Alexandre Bozec
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
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Mendenhall WM, Beitler JJ, Saba NF, Shaha AR, Nuyts S, Strojan P, Bollen H, Cohen O, Smee R, Ng SP, Eisbruch A, Ng WT, Kirwan JM, Ferlito A. Proton Beam Radiation Therapy for Oropharyngeal Squamous Cell Carcinoma. Int J Part Ther 2023; 9:243-252. [PMID: 37169005 PMCID: PMC10166016 DOI: 10.14338/ijpt-22-00030.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/10/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose To discuss the role of proton beam therapy (PBT) in the treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC). Materials and Methods A review of the pertinent literature. Results Proton beam therapy likely results in reduced acute and late toxicity as compared with intensity-modulated radiation therapy (IMRT). The extent of the reduced toxicity, which may be modest, depends on the endpoint and technical factors such as pencil beam versus passive scattered PBT and adaptive replanning. The disease control rates after PBT are likely similar to those after IMRT. Conclusion Proton beam therapy is an attractive option to treat patients with OPSCC. Whether it becomes widely available depends on access.
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Affiliation(s)
- William M. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jonathan J. Beitler
- Harold Alfonds Center for Cancer Care, Maine General Hospital, Augusta, ME, USA
| | - Nabil F. Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ashok R. Shaha
- Department of Head and Neck Surgery and Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sandra Nuyts
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium
- Laboratory of Experimental Radiotherapy, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Heleen Bollen
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium
| | - Oded Cohen
- Department of Otolaryngology - Head and Neck Surgery and Oncology, Soroka Medical Center, Tel Aviv, Affiliated with Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jessica M. Kirwan
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Rajkumar B, Parameswaran R, Sanjana M, Boovaraghavan S, Vijayalakshmi D. Evaluation of pharyngeal airway volume three-dimensionally in various sagittal skeletal patterns - Systematic review. Indian J Dent Res 2023; 34:209-215. [PMID: 37787215 DOI: 10.4103/ijdr.ijdr_338_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
To investigate the pharyngeal airway volume in different anteroposterior skeletal malocclusions. This study was prepared according to the Cochrane criteria for creating a systematic review and meta-analysis and confirms the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. This search was conducted to answer the patient/population, intervention, comparison and outcomes (PICO) question: To evaluate (outcome) and compare (comparison) whether there is a difference in airway volume in patients (participants) with different skeletal malocclusions diagnosed using 3D data (intervention).The first two authors extracted the data from the included studies and assessed the risk of bias in the individual studies using the Newcastle-Ottawa scale. Meta-analysis was done using STATA version 16, which compared various three-dimensional pharyngeal airway parameters in skeletal Class II and skeletal Class III malocclusions with that of skeletal class I malocclusion. Out of 370 articles from the initial search, 17 articles were included in the systematic review. Out of 17 studies, 12 eligible studies were included in the quantitative synthesis. The nasopharynx, oropharynx, hypopharynx, and total airway volume were increased in skeletal Class I malocclusion compared to that of skeletal Class II malocclusion and decreased in comparison to skeletal Class III malocclusion. The moderate quality of evidence indicates the total airway volume, oropharynx, and hypopharynx are largest in skeletal Class III compared to Class I and Class II skeletal malocclusion.
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Affiliation(s)
- Balaji Rajkumar
- Department of Orthodontics and Dentofacial Orthopedics, Meenakshi Ammal Dental College and Hospital, Meenakshi University (MAHER), Chennai, Tamil Nadu, India
| | - Ratna Parameswaran
- Department of Orthodontics and Dentofacial Orthopedics, Meenakshi Ammal Dental College and Hospital, Meenakshi University (MAHER), Chennai, Tamil Nadu, India
| | - Mary Sanjana
- Department of Orthodontics and Dentofacial Orthopedics, Meenakshi Ammal Dental College and Hospital, Meenakshi University (MAHER), Chennai, Tamil Nadu, India
| | - Srinivasan Boovaraghavan
- Department of Orthodontics and Dentofacial Orthopedics, Meenakshi Ammal Dental College and Hospital, Meenakshi University (MAHER), Chennai, Tamil Nadu, India
| | - Devaki Vijayalakshmi
- Department of Orthodontics and Dentofacial Orthopedics, Meenakshi Ammal Dental College and Hospital, Meenakshi University (MAHER), Chennai, Tamil Nadu, India
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36
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Takeuchi A, Hyodoh H, Jin S, Tanaka S, Murakami M, Minowa K, Matoba K. Objective Evaluation of Oral and Pharyngeal Areas in Autopsy Cases of Obstructive Sleep Apnea Syndrome via Postmortem CT. Curr Med Imaging 2023:CMIR-EPUB-130381. [PMID: 37018520 DOI: 10.2174/1573405620666230328082804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/07/2023] [Accepted: 01/25/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) can cause sudden death during sleep. Previous findings have suggested that OSAS development is related to maxillofacial morphology. Evaluation of facial morphology can determine the risk of developing the disease, and establishing an objective method to assess the underlying etiology of OSAS-related death would be advantageous. OBJECTIVE The objective of this study is to determine the key features of obstructive sleep apnea syndrome (OSAS) using postmortem oral and pharyngeal computed tomography (CT). METHODS We retrospectively assessed autopsy cases of patients with (n=25) and without (n=25) OSAS-related death. We used oral and pharyngeal CT images to compare the oral and pharyngeal cavity volume (OPCV), oral and pharyngeal soft tissue volume (OPSV), oral and pharyngeal air space volume (OPAV), and OPAV to OPCV ratio (%air). Receiver operating curve (ROC) analysis was used to determine the accuracy of OSAS prediction. We assessed participants with body mass index (BMI) values within the normal range. RESULTS Among the 50 subjects, we observed significant between-group differences in OPSV, OPAV, and % air, whereas there were significant between-group differences in OPSV and %air among 28 subjects with normal BMI values. Both comparisons suggested that OSAS-related death was associated with low %air and high OPSV values. CONCLUSION The %air and OPSV are useful for assessing postmortem oropharyngeal CT images. OSAS-related sudden death is likely when %air and OPSV values are ≤20.1% and ≥127.2 ml, respectively. Among those with normal BMI values, % air and OPSV values of ≤22.8% and ≥111.5 ml, respectively, predict OSAS-related sudden death.
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Affiliation(s)
- Akiko Takeuchi
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Radiology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Hideki Hyodoh
- Department of Forensic Medicine, Graduate School of Medicine, Fukui University, Japan
| | - Shigeki Jin
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Tanaka
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Manabu Murakami
- Hokkaido University Center for Medical Education and International Relations, Faculty of Medicine Sapporo Japan
| | - Kazuyuki Minowa
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Radiology, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Kotaro Matoba
- Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Forensic Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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37
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Imam T, Konstant-Hambling R, Flint H, Brooks TA, Patel NN, Conroy S. The Hospital Frailty Risk Score and outcomes in head and neck cancer surgery. Clin Otolaryngol 2023. [PMID: 36950831 DOI: 10.1111/coa.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/25/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE This study aimed to assess if the Hospital Frailty Risk Score (HFRS) could predict outcomes for older people undergoing head and neck procedures. DESIGN A retrospective cohort study of patients admitted between April 2008 and February 2020, undergoing head and neck procedures defined as major resections using procedural codes. SETTING The analysis was performed using data from the NHS Secondary Uses Service (SUS) electronic database. PARTICIPANTS A number of 7479 patients were selected based on an age of 75 years and above and an admission associated with a diagnostic code associated with a head and neck cancer. Based on HFRS, 5153 patients were risk-stratified into mild, moderate, and severe frailty risk. MAIN OUTCOME MEASURES The relationships between frailty risk and length of stay, readmission rate, and mortality were quantified using descriptive statistics. RESULTS Severely frail patients had a median length of stay of 9 days compared to 3 for mildly frail patients. Twenty-seven percentage of severely frail patients were readmitted within 30 days of surgery. Rising levels of frailty correlate with a higher risk of death following surgery which is maintained in longer term mortality at 1 year and until the data were extracted in March 2022. Fifty percentage of moderately frail patients and 66% of severely frail patients had died in hospital by the end of the study period. CONCLUSION The results quantify the relationship between frailty and adverse health outcomes. This information could be used to identify those that might benefit from holistic assessment, aid prognostication, commissioning, and service planning.
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Affiliation(s)
| | | | | | | | - Nimesh N Patel
- University Hospital Southampton NHS Foundation Trust, Hampshire, UK
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38
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Smith JD, Ludwig ML, Bhangale AD, Brummel C, Swiecicki PL, Worden FP, Chinn SB, Stucken CL, Rosko AJ, Prince MEP, Malloy KM, Casper KA, Bradford CR, Chepeha DB, Shah J, Schonewolf CA, McHugh JB, Nyati MK, Eisbruch A, Mierzwa ML, Spector ME, Brenner JC. Tumor immune microenvironment alterations using induction cetuximab in a phase II trial of deintensified therapy for p16-positive oropharynx cancer. Head Neck 2023; 45:1281-1287. [PMID: 36932871 DOI: 10.1002/hed.27344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/13/2023] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND We sought to characterize early changes in CD8+ tumor-infiltrating lymphocytes and tumor transcriptomes after induction cetuximab in a cohort with p16-positive oropharyngeal cancer on a phase II clinical de-escalation trial. METHODS Tumor biopsies were obtained before and 1 week after a single cetuximab loading dose in eight patients enrolled in a phase II trial of cetuximab and radiotherapy. Changes in CD8+ tumor-infiltrating lymphocytes and transcriptomes were assessed. RESULTS One week after cetuximab, five patients (62.5%) had an increase in CD8+ cell infiltration with a median (range) fold change of +5.8 (2.5-15.8). Three (37.5%) had unchanged CD8+ cells (median [range] fold change of -0.85 [0.8-1.1]). In two patients with evaluable RNA, cetuximab induced rapid tumor transcriptome changes in cellular type 1 interferon signaling and keratinization pathways. CONCLUSIONS Within 1 week, cetuximab induced measurable changes in pro-cytotoxic T-cell signaling and immune content.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Megan L Ludwig
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Apurva D Bhangale
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Collin Brummel
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Paul L Swiecicki
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Francis P Worden
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Andrew J Rosko
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Douglas B Chepeha
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Shah
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Caitlin A Schonewolf
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jonathon B McHugh
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mukesh K Nyati
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Avraham Eisbruch
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michelle L Mierzwa
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - J Chad Brenner
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Choi N, Lee C, Kim H, Koh S, Baek CH. Transoral barbed knotless continuous suture technique for oral/oropharyngeal defects after cancer ablation. Clin Otolaryngol 2023; 48:245-249. [PMID: 36378024 DOI: 10.1111/coa.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Nayeon Choi
- Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Changhee Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - HeeJung Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sungmin Koh
- Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Maulik S, Roy P, Mallick I, Prasath S, Arun B, Chatterjee S. Definitive chemoradiation for oropharyngeal squamous carcinomas: Outcomes with intensity-modulated radiation therapy using simultaneous integrated boost, in a majorly p16 negative cohort. Head Neck 2023; 45:1156-1161. [PMID: 36859789 DOI: 10.1002/hed.27328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The literature on modern-era outcomes of oropharyngeal squamous carcinoma (OPSCC) in India is limited. MATERIALS AND METHODS We analyzed records of consecutive patients with OPSCC treated using a curative SIB IMRT regimen of 66 Gy/30#/6 weeks. RESULTS One hundred fifteen patients from July 2011 to December 2018 were analyzed. Twenty of 69 patients tested positive for p16. In p16 positive patients, the K-M probability of being disease free and alive at 2 years, with at least one follow-up 3 months after treatment, was 83% (median not reached) compared with 48% if p16 was unknown/negative. Patients staged as IVB p16 negative had a 2-year DFS of 25%. Patients unfit for cisplatin and consequently received other agents had 2-year DFS estimated at 20%. CONCLUSIONS Intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) and concurrent chemotherapy was feasible, with toxicity and disease control comparable to available literature. AJCC Stage IVB p16 negative disease had notably poor outcome.
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Affiliation(s)
- Shaurav Maulik
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - Paromita Roy
- Department of Pathology, Tata Medical Center, Kolkata, India
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - Sriram Prasath
- Department of Physics, Tata Medical Center, Kolkata, India
| | - B Arun
- Department of Physics, Tata Medical Center, Kolkata, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
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Chen H, Emami E, Kauffmann C, Rompré P, Almeida F, Schmittbuhl M, van der Stelt P, Ge S, Lavigne G, Huynh N. Airway Phenotypes and Nocturnal Wearing of Dentures in Elders with Sleep Apnea. J Dent Res 2023; 102:263-269. [PMID: 36333889 DOI: 10.1177/00220345221133278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to examine to what extent the anatomic characteristics of the upper airway can influence the effect of nocturnal wearing of dentures on the sleep of edentulous elders with untreated sleep apnea. This study used the data from a randomized crossover clinical trial and an exploratory approach to address its objectives. Cone beam computed tomography scans of 65 edentulous individuals (female, n = 37; male, n = 28; mean ± SD age, 74.54 ± 6.42 y) with untreated obstructive sleep apnea (OSA) were used to identify anatomic variables. Polysomnography data were collected by means of one portable overnight recording. The respiratory variable values, including apnea-hypopnea index (AHI), with and without denture worn during sleep were used to calculate the change. Statistical analyses included multiple linear regressions, cluster analysis, and binary logistic regressions. A receiver operator characteristic curve was used to illustrate the accuracy of the statistical model. The regression model explained 15.8% (R2) of AHI change. An increase in the lateral dimension of the minimum cross-sectional area was associated with a decrease in AHI, oxygen desaturation index, and respiratory arousal index changes (P ≤ 0.041). Furthermore, an increase in the length of the hypopharynx was associated with an increase in AHI and oxygen desaturation index changes (P ≤ 0.027). An increase in the lateral dimension of the minimum cross-sectional area of the upper airway was associated with a decreased likelihood of being in the group having a worsened AHI (odds ratio = 0.85; 95% CI, 0.76 to 0.95; P = 0.006). An increase in the length of the oropharynx was associated with an increased likelihood of having increased AHI (odds ratio = 1.10; 95% CI, 1.01 to 1.20; P = 0.026). The nocturnal aggravation of respiratory variables in edentulous individuals with OSA who wear dentures at night can be linked to certain anatomic characteristics of the upper airway. Replication of these findings may open novel avenues for personalized advice regarding nocturnal wearing of dentures in edentulous individuals with OSA (ClinicalTrials.gov: NCT01868295).
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Affiliation(s)
- H Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China.,Faculty of Dental Medicine, Université de Montréal, Montreal, Canada
| | - E Emami
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - C Kauffmann
- Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - P Rompré
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada
| | - F Almeida
- Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - M Schmittbuhl
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - P van der Stelt
- Academic Centre for Dentistry Amsterdam, Amsterdam, the Netherlands
| | - S Ge
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - G Lavigne
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - N Huynh
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
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Naidenova IL, Danilov AB, Simonova AV, Pilipovich AA, Filatova EG. [The state of the oropharyngeal microbiome in patients with migraine]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:112-119. [PMID: 36843467 DOI: 10.17116/jnevro2023123021112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To determine a role of changes in the oropharyngeal microbiome in the development and clinical manifestations of migraine. MATERIAL AND METHODS Seventy patients with migraine, aged 21-56 years, and 15 healthy subjects matched for age and sex were examined using headache diary, MIDAS and VAS, the Gastrointestinal Symptom Rating Scale (GSRS), microbiological smear examination from the mucous membrane of the posterior wall of the oropharynx with evaluation by the method of mass spectrometry of microbial markers (MSMM) with determination of 57 microorganisms. RESULTS The following changes in the oropharynx of individuals with migraine compared with the group of healthy individuals (control group) were found: a) a significant increase in the content of markers of resident (conditionally pathogenic) microorganisms characteristic of chronic diseases of the upper respiratory tract (strepto- and staphylococci); b) the appearance of markers of transient microorganisms normally absent, characteristic of the intestinal microflora (clostridia, gram-negative rods, enterobacteria, anaerobes); c) the appearance of viral markers of cytomegaloviruses, Herpes group, Epstein-Barr; d) a significant decrease in the content of bifidobacteria and lactobacilli). All people with migraine had a history or were found on examination to have chronic diseases of the upper respiratory tract (sinusitis in 48%, pharyngitis in 43%, tonsillitis in 25% of people), and gastrointestinal diseases. Dyspepsia was the most frequent and pronounced of the gastrointestinal syndromes on the GSRS in people with migraine (87%). This corresponds to the data on the extremely frequent occurrence of IBS (70% of patients) and other gastrointestinal pathology obtained from the patient history. CONCLUSION In our work, the microbiota of the oropharynx in patients with migraine was studied for the first time using a new MSMM method. Disturbance of the oropharyngeal microbiome compared to the norm was detected in 100% of people with migraine. The changes characteristic of most patients included a significant decrease in the content of normal flora, an increase in the concentration of conditionally pathogenic microorganisms and the appearance of pathogenic microflora characteristic of chronic diseases of the upper respiratory tract and gastrointestinal tract, which may indicate their role in the pathogenesis of migraine.
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Affiliation(s)
- I L Naidenova
- MEDSI Clinical and Diagnostic Center on Krasnaya Presnya, Moscow, Russia
| | - A B Danilov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A V Simonova
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - A A Pilipovich
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - E G Filatova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Bach L, Ram A, Ijaz UZ, Evans TJ, Haydon DT, Lindström J. The Effects of Smoking on Human Pharynx Microbiota Composition and Stability. Microbiol Spectr 2023; 11:e0216621. [PMID: 36786634 PMCID: PMC10101099 DOI: 10.1128/spectrum.02166-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/16/2023] [Indexed: 02/15/2023] Open
Abstract
The oral microbiota is essential to the health of the host, yet little is known about how it responds to disturbances. We examined the oropharyngeal microbiota of 30 individuals over 40 weeks. As the oropharynx is an important gateway to pathogens, and as smoking is associated with increased incidence and severity of respiratory infections, we compared the microbiota of smokers and nonsmokers to shed light on its potential for facilitating infections. We hypothesized that decreased species diversity, decreased community stability, or increased differences in community structure could facilitate invading pathogens. We found that smoking is associated with reduced alpha diversity, greater differences in community structure, and increased environmental filtering. The effects of short-term perturbations (antibiotic use and participants exhibiting cold symptoms) were also investigated. Antibiotic use had a negative effect on alpha diversity, irrespective of smoking status, and both antibiotic use and cold symptoms were associated with highly unique bacterial communities. A stability analysis of models built from the data indicated that there were no differences in local or global stability in the microbial communities of smokers, compared to nonsmokers, and that their microbiota are equally resistant to species invasions. Results from these models suggest that smoker microbiota are perturbed but characterized by alternative stable states that are as stable and invasion-resistant as are the microbiota of nonsmokers. Smoking is unlikely to increase the risk of infectious disease through the altered composition and ecological function of the microbiota; this is more likely due to the effects of smoking on the local and systemic immune system. IMPORTANCE Smoking is associated with an increased risk of respiratory infections. Hypothetically, the altered community diversity of smokers' pharyngeal microbiota, together with changes in their ecological stability properties, could facilitate their invasion by pathogens. To address this question, we analyzed longitudinal microbiota data of baseline healthy individuals who were either smokers or nonsmokers. While the results indicate reduced biodiversity and increased species turnover in the smokers' pharyngeal microbiota, their ecological stability properties were not different from those of the microbiota of nonsmokers, implying, in ecological terms, that the smokers' microbial communities are not less resistant to invasions. Therefore, the study suggests that the increased propensity of respiratory infections that is seen in smokers is more likely associated with changes in the local and systemic immune system than with ecological changes in the microbial communities.
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Affiliation(s)
- Lydia Bach
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, United Kingdom
| | - Asha Ram
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, United Kingdom
| | - Umer Z. Ijaz
- School of Science and Engineering, University of Glasgow, United Kingdom
| | - Thomas J. Evans
- School of Infection and Immunity, Glasgow Biomedical Research Centre, University of Glasgow, United Kingdom
| | - Daniel T. Haydon
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, United Kingdom
| | - Jan Lindström
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, United Kingdom
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Govindagoudar MB, Lalwani LK, Singh PK, Sen J, Chaudhry D. Dynamic assessment of oropharynx with ultrasonography as a screening tool for obstructive sleep apnea. J Sleep Res 2023; 32:e13712. [PMID: 36054478 DOI: 10.1111/jsr.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 02/03/2023]
Abstract
Ultrasonography is an easily available and portable tool to assess the dynamic changes in the upper airway and surrounding soft tissue. This study aimed to evaluate the utility of oropharynx ultrasonography as a screening tool for obstructive sleep apnea (OSA). The study sequentially enrolled overweight individuals (body mass index >25 kg/m2 ) and subjected them to OSA screening tools (Berlin questionnaire, Epworth Sleepiness Scale and STOP-Bang scores), ultrasonography of the oropharynx followed by overnight polysomnography. A total of 30 healthy individuals were also recruited as controls. Detailed dynamic and static ultrasonography measurements of the oropharynx and surrounding tissue were done. The diagnostic ability of various ultrasonography parameters to detect OSA was determined using receiver operating characteristic curve analysis. A total of 63 subjects were enrolled, with 33 in the OSA group and 30 in non-OSA overweight group. All baseline characteristics were similar in the two groups. Except for the dynamic measurements of oropharynx (Retropalatal% change-inspiration, retropalatal% change-Muller manoeuvre, retroglossal% change-inspiration, and retroglossal% change-Muller manoeuvre) all other parameters were similar in the OSA and non-OSA overweight subjects. The area under the receiver operating characteristic curve was highest for retropalatal% change-inspiration: 0.989, followed by retropalatal% change-Muller manoeuvre: 0.988. Both were also significant predictors of OSA with odds ratios of 0.338 (p = 0.003; 95% confidence interval [CI] 0.164-0.696) and 0.346 (p = 0.018; 95% CI 0.143-0.837), respectively. Ultrasonography provides a near complete picture of the dynamic changes and collapsibility of the oropharynx and can be an effective tool in screening for OSA.
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Affiliation(s)
- Manjunath B Govindagoudar
- Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Lokesh Kumar Lalwani
- Department of Respiratory Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Pawan Kumar Singh
- Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Jyotsna Sen
- Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India
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Jeong HG, Kim T, Hong JE, Kim HJ, Yun SY, Kim S, Yoo J, Lee SH, Thomas RJ, Yun CH. Automated deep neural network analysis of lateral cephalogram data can aid in detecting obstructive sleep apnea. J Clin Sleep Med 2023; 19:327-337. [PMID: 36271597 PMCID: PMC9892734 DOI: 10.5664/jcsm.10258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVES Information on obstructive sleep apnea (OSA) is often latently detected in diagnostic tests conducted for other purposes, providing opportunities for maximizing value. This study aimed to develop a convolutional neural network (CNN) to identify the risk of OSA using lateral cephalograms. METHODS The lateral cephalograms of 5,648 individuals (mean age, 49.0 ± 15.8 years; men, 62.3%) with or without OSA were collected and divided into training, validation, and internal test datasets in a 5:2:3 ratio. A separate external test dataset (n = 378) was used. A densely connected CNN was trained to diagnose OSA using a cephalogram. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Gradient-weighted class activation mapping (Grad-CAM) was used to evaluate the region of focus, and the relationships between the model outputs, anthropometric characteristics, and OSA severity were evaluated. RESULTS The AUROC of the model for the presence of OSA was 0.82 (95% confidence interval, 0.80-0.84) and 0.73 (95% confidence interval, 0.65-0.81) in the internal and external test datasets, respectively. Grad-CAM demonstrated that the model focused on the area of the tongue base and oropharynx in the cephalogram. Sigmoid output values were positively correlated with OSA severity, body mass index, and neck and waist circumference. CONCLUSIONS Deep learning may help develop a model that classifies OSA using a cephalogram, which may be clinically useful in the appropriate context. The definition of ground truth was the main limitation of this study. CITATION Jeong H-G, Kim T, Hong JE, et al. Automated deep neural network analysis of lateral cephalogram data can aid in detecting obstructive sleep apnea. J Clin Sleep Med. 2023;19(2):327-337.
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Affiliation(s)
- Han-Gil Jeong
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Eun Hong
- Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Ji Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - So-Yeon Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sejoong Kim
- Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jun Yoo
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Robert Joseph Thomas
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Abstract
Human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPSCC) has one of the most rapidly increasing incidences of any cancer in high-income countries. The most recent (8th) edition of the Union for International Cancer Control/American Joint Committee on Cancer staging system separates HPV-OPSCC from its HPV-negative counterpart to account for the improved prognosis seen in the former. Indeed, owing to its improved prognosis and greater prevalence in younger individuals, numerous ongoing trials are examining the potential for treatment deintensification as a means to improve quality of life while maintaining acceptable survival outcomes. Owing to the distinct biology of HPV-OPSCCs, targeted therapies and immunotherapies have become an area of particular interest. Importantly, OPSCC is often detected at an advanced stage, highlighting the need for diagnostic biomarkers to aid in earlier detection. In this review, we highlight important advances in the epidemiology, pathology, diagnosis, and clinical management of HPV-OPSCC and underscore the need for a progressive understanding of the molecular basis of this disease toward early detection and precision care.
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Affiliation(s)
| | - William Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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Hirna HA, Maltsev DV, Rozhko MM, Kostyshyn ID. Results of the study of mucosal immunity indices in patients with cancer of the oral cavity and oropharynx during radiotherapy or chemoradiotherapy therapy and immunotherapy with α/β-defensins. Klin Onkol 2023; 36:112-123. [PMID: 37072245 DOI: 10.48095/ccko2023112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND The aim of the study was to investigate the concentration of interferon (INF) -a, INF- g, interleukin (IL) -6, and secretory IgA (sIgA) in saliva during various regimens of antitumour treatment and immunotherapy (IT) with a/b-defensins in patients with cancer of the oral cavity and oropharynx in order to find ways to increase the effectiveness and improvement of the tolerability of antitumour treatment on the base of the identification of biomarkers for the evaluation of the antitumour effect and the prediction of complications. MATERIALS AND METHODS We have studied the changes in the immunity indices of 105 patients who were diagnosed with squamous cell carcinoma of the oral cavity or oropharynx for the first time. The patients received radiotherapy (RT) or chemoradiotherapy and IT with a/b-defensins in different doses (40 and 60 mg) at the 1st phase of the special treatment. RESULTS A determined drop in the concentration of INF-a after cytostatic treatment, and the additional use of IT with a/b-defensins in different doses do not produce the protective effect on the production of INF-a. Regarding INF- g, a more than two-fold decrease in the concentration of INF- g in the saliva of patients in group receiving a double dose of an immunotherapeutic agent along with radiation therapy (RT) was noted, which may indicate an adjuvant effect of a/b-defensins in relation to RT, enhancing its antitumour influence, and thereby ensuring the regression of neoplasia. In case of an increased dose of a/b-defensins use during RT, there was found immunomodulatory effect in relation to IL-6. In the group of patients who received RT and a higher dose of the immune agent, the "scissors phenomenon" was noted - a simultaneous decrease in the concentration of INF- g and an increase in the concentration of sIgA in saliva, which, taking into account the reduced risk of mucositis and better regression of the tumour, shows the meaningful adjuvant and immunomodulating effects of a/b-defensin therapy in the study group. CONCLUSION High-dose IT with a/b-defensins against the background of cytostatic therapy in patients with cancer of the oral cavity and oropharynx potentially leads to an adjuvant and immunomodulatory effect with a decrease in the concentration of INF- g and a parallel increase in the concentration of sIgA in saliva, i.e., reconstruction of the immune response from Th1- to Th2-profile - the profile associated with the tumour regression. With the development of the radio-induced mucositis in these patients, a decrease in concentration of sIgA in saliva with a tendency to a progressive decrease of this index with the increase of mucositis severity was noted. The data obtained allow us to consider INF- g and sIgA as biomarkers of the effectiveness of traditional anticancer therapy during the use of a/b-defensins, and sIgA as a biomarker of the risk of developing radio-induced mucositis in patients with cancer of the oral cavity and oropharynx, which should be verified in further clinical studies with better design.
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Miellet WR, Almeida ST, Trzciński K, Sá-Leão R. Streptococcus pneumoniae carriage studies in adults: Importance, challenges, and key issues to consider when using quantitative PCR-based approaches. Front Microbiol 2023; 14:1122276. [PMID: 36910231 PMCID: PMC9994646 DOI: 10.3389/fmicb.2023.1122276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Streptococcus pneumoniae causes significant morbidity and mortality among older adults. Detection of pneumococcal carriage is an accepted endpoint in pneumococcal conjugate vaccine studies. However, low sensitivity of culture-based approaches and nasopharyngeal samples have hampered adult S. pneumoniae carriage studies in the past. In contrast, detection of adult S. pneumoniae carriers with qPCR-based approaches can achieve high sensitivity and specificity and qPCR-based testing of oral samples improves accuracy of adult carriage detection. In this Viewpoint we outline a strategy for accurate qPCR-based testing. We recommend a dual-target approach for S. pneumoniae qPCR detection as no genetic target is universally present among or solely unique to it. Furthermore, we advise the evaluation of concordance among quantified qPCR targets to improve the accuracy of S. pneumoniae testing and qPCR-based serotyping. We do not recommend omission of qPCR-based oral sample testing as it will likely result in an underestimation of true adult carrier rates.
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Affiliation(s)
- Willem R Miellet
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Sónia T Almeida
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Krzysztof Trzciński
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Raquel Sá-Leão
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
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Chen Q, Liu M, Lin Y, Wang K, Li J, Li P, Yang L, Jia L, Zhang B, Guo H, Li P, Song H. Topography of respiratory tract and gut microbiota in mice with influenza A virus infection. Front Microbiol 2023; 14:1129690. [PMID: 36910185 PMCID: PMC9992211 DOI: 10.3389/fmicb.2023.1129690] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Influenza A virus (IAV)-induced dysbiosis may predispose to severe bacterial superinfections. Most studies have focused on the microbiota of single mucosal surfaces; consequently, the relationships between microbiota at different anatomic sites in IAV-infected mice have not been fully studied. Methods We characterized respiratory and gut microbiota using full-length 16S rRNA gene sequencing by Nanopore sequencers and compared the nasopharyngeal, oropharyngeal, lung and gut microbiomes in healthy and IAV-infected mice. Results The oropharyngeal, lung and gut microbiota of healthy mice were dominated by Lactobacillus spp., while nasopharyngeal microbiota were comprised primarily of Streptococcus spp. However, the oropharyngeal, nasopharyngeal, lung, and gut microbiota of IAV-infected mice were dominated by Pseudomonas, Escherichia, Streptococcus, and Muribaculum spp., respectively. Lactobacillus murinus was identified as a biomarker and was reduced at all sites in IAV-infected mice. The microbiota composition of lung was more similar to that of the nasopharynx than the oropharynx in healthy mice. Discussion These findings suggest that the main source of lung microbiota in mice differs from that of adults. Moreover, the similarity between the nasopharyngeal and lung microbiota was increased in IAV-infected mice. We found that IAV infection reduced the similarity between the gut and oropharyngeal microbiota. L. murinus was identified as a biomarker of IAV infection and may be an important target for intervention in post-influenza bacterial superinfections.
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Affiliation(s)
- Qichao Chen
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China.,Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Manjiao Liu
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, Jiangsu Province, China.,Nanjing Simcere Medical Laboratory Science Co., Ltd., Nanjing, Jiangsu Province, China
| | - Yanfeng Lin
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China.,Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Kaiying Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Peihan Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Lang Yang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Leili Jia
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Bei Zhang
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, Jiangsu Province, China.,Nanjing Simcere Medical Laboratory Science Co., Ltd., Nanjing, Jiangsu Province, China
| | - Hao Guo
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, Jiangsu Province, China.,Nanjing Simcere Medical Laboratory Science Co., Ltd., Nanjing, Jiangsu Province, China
| | - Peng Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hongbin Song
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China.,Chinese PLA Center for Disease Control and Prevention, Beijing, China
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Dickstein DR, Powers AE, Vujovic D, Roof S, Bakst RL. Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer. Clin Interv Aging 2023; 18:409-422. [PMID: 36959837 PMCID: PMC10029371 DOI: 10.2147/cia.s366155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
Approximately 30% of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age, and this percentage is expected to increase as the population increases and lives longer. Elderly patients are underrepresented in head and neck oncology clinical trials, and there is minimal evidence on the management of HNSCC for this population. Subsequently, despite their best intentions, physicians may unknowingly recommend an ill-suited course of therapy, which may result in suboptimal oncological or functional outcomes or adverse events. Surgical approaches have the potential to carry a higher risk of morbidity and mortality in older adults, especially in patients with multiple comorbidities. Definitive radiation therapy treatment in patients with HNSCC frequently involves 7 weeks of daily radiation, sometimes with concurrent chemotherapy, and this demanding treatment can be difficult for older adult patients, which may lead to treatment interruptions, potential removal of concurrent systemic therapy, compromised outcomes, and diminished quality of life. There are clinical trials currently underway investigating altered fractionation regimens and novel, less toxic systemic treatments in this population. This review provides an overview of how best to approach an older adult with HNSCC, from initial work-up to treatment selection.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann E Powers
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dragan Vujovic
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Roof
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Correspondence: Richard L Bakst, Icahn School of Medicine at Mount Sinai, 1184 5th Avenue 1st Fl, Box 1236, New York, NY, 10029, USA, Tel/Fax +1 212 241 3545, Email
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